NEET 41-45

NEET 41-45

Questions similar to NEET SS and DNB 

Questions 6-10           Questions 11-15            Questions 16-20        Questions 21-25

Questions 31-35 (Chest)        Questions 36-40                      Questions 46-50                  More:


Q41) Simple nipple inversion is seen in

a) Duct ectasia

b) Puberty

c) Peri ductal fibrosis

d) Carcinoma breast


Q 42) Radiofrequency ablation used in treatment of GERD is 

a) Stretta

b) Linx

c) Esophy X

d) None of these


Q43) PGDFR mutation is seen in which disease

a) GIST

b) Carcinoid

c) NET

d) Carcinoma esophagus


Q44) Most common complication after Whipple's operation is 

a) Delayed gastric emptying

b) Pneumonia

c) Pancreaticojejunostomy leak

d) Wound infection


Q45) Pulmonary tractotomy is used for

a) Lobectomy

b) Bleeding control in lung injury

c) Pneumothorax decompression

d) Hemothorax drainage


Answers

41) b

Inversion of nipples can be seen in a lot of conditions, both benign and malignant. Common causes are 

  1. Duct ectasia
  2.  After breast Surgery
  3. Fat necrosis
  4. Mondor disease
  5. Chronic peri ductal mastitis
  6. Carcinoma breast 

Rapid unilateral development of inversion of nipple is a dangerous sign and warrants further diagnosis. Further circumferential retraction is also sign of carcinoma.

Simple nipple inversion occurring at puberty  or retracted nipple is of unknown cause and is bilateral in 25%. No treatment is required for this.

Ref - Bailey 801

Grading of benign nipple inversions for management

In grade I, the nipple is easily pulled out manually and maintains its projection quite well.  It has minimal fibrosis  thus, manual traction and a single, buried purse-string suture are enough for the correction.

Grade II (majority)  the nipples can be pulled out but cannot maintain projection and tend to go back again. These nipples are thought to have moderate fibrosis beneath the nipple.

In grade III, to which the least number of inverted-nipple cases belong, the nipple can hardly be pulled out manually. Severe fibrosis made it impossible to reach optimal release of the fibrotic band with the preservation of the ducts.

Ref https://www.ncbi.nlm.nih.gov/pubmed/10654681


42 a

Radiofrequency ablation works on the principle of inducing injury to the muscle layer of esophagus  and inducing fibrotic reaction. This technique spares the mucosa and fibrotic reaction produced at the cardia reinforces the GE junction.

Stretta is the radio frequency device that does it. Thermal applications are given in 0.5 cm areas above and below the GE junction. Most common symptoms that get relieved with this treatment are heartburn and cough. Regurgitation is often not relieved or partially relieved.

EndoCinch is Transoral plication technique

Esophy X same transoral plication

Linx system augments sphincter competence using titanium beads with magnets

Ref: schakelford page 270-274

43. a

GIST shows two main mutations-

1st is CD117 seen in 95% and 2nd is PGDFR mutation seen in 5%

44. a

Delayed gastric emptying is seen in 20% of cases. Most of the times it resolves but it indicates some intra abdominal collection or deviation from normal course of recovery.

PJ leak is seen in 12% and can be fatal. Depending on the amount of leak, it may be managed with prolonged drainage alone or re exploration and drainage.

Wound infection is 7%

Respiratory complications are rare 

Others include Intra abdominal abscess and cardiac events

Ref: Sabiston 1548


45) b

It is a surgical technique in which bleeding from through and through lung injuries is controlled.  Technique involves laying open of the tract and individually ligating the bronchi and blood vessels.

It prevents a lobectomy and has similar results to it

Ref

Wall MJ Jr, Hirshberg A, Mattox KL. Pulmonary tractotomy with selective vascular ligation for penetrating injuries to the lung. Am J Surg. 1994;168:665-9

Asensio JA, Demetriades D, Berne JD et al. Stapled pulmonary tractotomy: a rapid way to control hemorrhage in penetrating pulmonary injuries. J Am Coll Surg. 1997;185:486-7

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